Be aware of the new reporting requirements that apply for the next PAMA data reporting period starting in January 2022. Explanation: Section 3718 of the Coronavirus Aid, Relief and Economic Security … [Read more...]
BILLING
OIG Work Plan Targets Medicare Part B Billing & Payment of Lab Tests
June 28, 2021
During the Public Health Emergency (PHE), the Department of Health and Human Services (HHS) has cut labs extraordinary slack in the form of waivers that temporarily loosen Medicare test coverage rules … [Read more...]
PAMA
ACLA Keeps the Pressure on CMS by Appealing Dismissal of PAMA Lawsuit
June 28, 2021
The American Clinical Laboratory Association (ACLA) is not backing down. For more than three years, the association has waged litigation warfare challenging the legality of CMS’s methodology for … [Read more...]
PAMA
Labs Lose a Battle But May Win the War Over Market-Based Pricing
May 10, 2021
In its crusade to get CMS to fix its warped Protecting Access to Medicare Act of 2014 (PAMA) market-based Medicare Part B pricing scheme, the lab industry lost a battle but may still end up winning … [Read more...]
PAMA
MedPAC Explores Simplified PAMA Reporting to Cut Burdens & Restore Lab Prices
May 10, 2021
The upcoming report of the Medicare Payment Advisory Commission (MedPAC) gives the lab industry new hopes for relief from the administrative burdens of Protecting Access to Medicare Act of 2014 (PAMA) … [Read more...]
PAMA
MedPAC Explores Simplified PAMA Reporting to Cut Burdens & Restore Lab Prices
April 22, 2021
The upcoming report of the Medicare Payment Advisory Commission (MedPAC) gives the lab industry new hopes for relief from the administrative burdens of Protecting Access to Medicare Act of 2014 (PAMA) … [Read more...]
HHS Announcement
The FDA Drops a Bombshell: No More EUA Review of COVID-19 LDTs
October 19, 2020
Perhaps one of the only positive things to come out of the COVID-19 crisis has been its exposure of the flaws in the FDA’s ham-handed system (if it can be called a system) of premarket regulation of … [Read more...]
OIG Findings
OIG Reports that 2018 Medicare Part B Lab Test Spending Increased Despite PAMA Cuts
September 18, 2020
It wasn’t supposed to happen like this. The expectation was that the new PAMA market-based pricing system was going to save Medicare 10 percent or more on lab test reimbursements. But it hasn’t … [Read more...]
Fee Schedules
2021 Medicare Physician Fee Schedule Slashes Lab Reimbursements 5% but Provides Some PAMA Relief
September 4, 2020
On Aug. 3, CMS released the proposed Medicare Physician Fee Schedule (PFS) rule for 2021. Bottom line on top: The agency is slashing lab reimbursement rates. Here are the four key takeaways for labs. … [Read more...]
Reimbursement
OIG Medicare Lab Spending Report May Warn of Greater Scrutiny of Genetic and Automated Chemistry Tests
August 29, 2020
PAMA and market-based rate reductions for lab testing was supposed to save Medicare bundles of money. But according to a new OIG report, Medicare Part B spending on lab spending for 2018, the first … [Read more...]
